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Date run 1/24/2011 2:11:23PN SAN,' UIN COUNTY ENVIRONMENTAL HEl DEPARTMENT Report#5021 <br /> Run by 5290 Pagel <br /> Facility Information as of 1/24/2011 <br /> Record Selection Criteria: Facility ID FA0010286 <br /> Make changes/corrections in RED ink. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION SSN/Fed Tax ID <br /> Owner ID OW0008286 Case Number: 7612 New Owner ID <br /> Owner Name LAWLEY, RODNEY <br /> Owner DBA MR TRUCKER INC <br /> Owner Address 2710 LOOMIS RD <br /> STOCKTON, CA 952058008 <br /> Home Phone Not Specified <br /> Work/Business Phone 209-462-9168 nn <br /> Mailing Address r6 a X .)--7-7 <br /> Care of <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0010286 <br /> Facility Name MR TRUCKER INC <br /> Location 2710 LOOMIS RD <br /> STOCKTON, CA 952058020 <br /> Phone 209-462-9168 <br /> Mailing Address <br /> Care of <br /> Location Code 99 - UNINCORPORATED A Alt Phone <br /> BOS District 001 -VILLAPUDUA Fax <br /> APN 17910043 EMail: <br /> EMERGENCY NOTIFICATION CONTACT INFORMATION <br /> Contact Name RODNEY LAWLEY <br /> Title PRESIDENT <br /> Day Phone 209-462-9168 <br /> Night Phone 209-339-0509 <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0017286 New Account ID: <br /> Mail Invoices to Facility Mail Invoices to: Owner / Facility / Account <br /> Account Name MR TRUCKER INC (Circle One) <br /> Account Balance as of 1/24/2011: $0.00 <br /> (Circle One) <br /> Transfer to Active/Inaclve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> 2220-SM HW GEN<5 TONS/YR PR0514271 EE0001421 -STACY RIVERA Active Y N A I D <br /> 2224-HAZ MAT BUSINESS PLAN AUTHORIZATIOIPRO512574 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2244-PACT TRANSFER RECORD-OES PRO520200 EE0000000-HAZ MAT SJC OES Active Y N A I D <br /> 2399-UNIFIED PROGRAM FAC STATE SURCHAR,PR0510286 EE0000000-HAZ MAT SJC OES Inactive Y N A I D <br /> 2832-AST FAC 10 K-</=100 K GAL CUMULATIVEPRO528415 EE0001421 -STACY RIVERA Active Y N A I D <br /> 4740-WASTE TIRE SITE-EXEMPT PR0525985 EE0002622-BENJAMIN ESCOTTO Inactive Y N A I D <br /> ERSC-ELECTRONIC REPORTING SURCHARGE PRO531797 Active Y N A I D <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associated with this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: _ Date <br /> Program Records to be TRANSFERED: `$25.00= Amount Paid Date <br /> Water System to be TRANSFERED: Amount Paid Date / / <br /> Payment Type Check Number Receiv d by <br /> RENS: Date / _/ Account out: — LCL_ Date <br /> COMMENTS: <br /> \\eh-env\envision\reports\5021.rpt <br />